Clinical Electrophysiology -> SVT/AVNRT/WPW/AT: -> Epidemiology of Cardiac Arrhythmias/ Epidemiology D-PO04 - Poster Session IV (ID 15) Poster

D-PO04-242 - Care Of Children With Supraventricular Tachycardia In The Emergency Department (ID 510)

 R. Przybylski: Nothing relevant to disclose.


Background: Supraventricular tachycardia (SVT) is the most common tachyarrhythmia in childhood.
Objective: We sought to describe emergency department (ED) visits made by children for SVT and variability between centers in evaluation and management.
Methods: We used the Pediatric Health Information System (PHIS) to analyze ED visits by children < 18 years old to 33 pediatric centers for SVT from 2010-2017. We included ED visits in which SVT was the primary diagnosis and intravenous (IV) adenosine was administered. We evaluated variability in, and factors associated with, hospital disposition, second line IV antiarrhythmic medication usage, and diagnostic testing. Diagnoses were ascertained using International Classification for Disease version 9 and 10 codes.
Results: We identified 2329 ED visits by 1738 children treated with adenosine for SVT. Median patient age was 6.3 (IQR 1.5-11.9) years. Ventricular pre-excitation was present in 611 (26%) visits, structural congenital heart disease in 631 (27%), and cardiomyopathy in 95 (4%). There were 2 deaths (0.1%). Marked variability existed between centers in admission rate (range 17-85%) and intensive care unit admission rate (range 4-60%). Factors associated with hospital admission included: younger age, male sex, and comorbid conditions. A second IV antiarrhythmic was required in 17% of visits and there was marked variation between centers regarding choice of second line agent. Amiodarone was used by 88% of centers, esmolol by 79%, digoxin by 58% and procainamide by 52%.
Conclusion: Management of SVT is highly variable between specialized pediatric centers, suggesting an opportunity for standardization in care of these children.